Category Archives: Medical treatments

Medical treatments for insanity were often harsh and punitive. They included the liberal use of narcotics. Doctors and attendants used drugs to sedate patients to make them easier to manage. Physical restraints were often used.

The Push West

Appalachian Homesteads Had Few Comforts, 1933, courtesy TVA archives

Appalachian Homesteads Had Few Comforts, 1933, courtesy TVA archives

In April, 1750, “Colby Chew and his horse fell down the bank,” wrote Dr. Thomas Walker, an Appalachian explorer, in his journal. “I bled and gave him valatile [sic] drops and he soon recovered.”*

Pioneers going to the West encountered harsh conditions as they moved away from settlement and civilization  (see last few posts), but the western frontier itself was an ever changing border. It began in what we would now say was the East, and simply slid westward as the growing population overwhelmed their available land and resources.

Huge Trees Led to Extensive Lumbering in Appalachia, photo circa 1895, courtesy of Shelley Mastran Smith and foresthistory.org

Huge Trees Led to Extensive Lumbering in Appalachia, photo circa 1895, courtesy of Shelley Mastran Smith and foresthistory.org

As might be expected, medicine and medical care on these borders were crude and unenlightened, though not much more so than what was seen  in cities. Bleeding a patient after a physical injury, as Walker did, sounds counterproductive today but was a common response to almost any illness during Walker’s time.

As each new frontier settled a bit and doctors moved into regions like Appalachia, they brought a variety of experiences, philosophies, and training with them. Doctors were not required to have licenses or even to attend medical school, and they thrived or failed upon the public’s perception of their success. When patients lived through bleeding, dosing with calomel (a toxic compound of mercury chloride), narcotics, and other dangerous concoctions, doctors–rather than the patient’s robust constitution–received credit for the recovery.

* Quoted from Frontier Medicine by Ron McCallister.

Medicine Wagon Allowed Traveling Medical Care

Medicine Wagon Allowed Traveling Medical Care

The Rest Cure

Dr. Silas Weir Mitchell

Dr. Silas Weir Mitchell

The rest cure was probably the most fashionable of responses to a condition of “nerves” or neurasthenia (see last three posts). Only the wealthy could afford such a complete withdrawal from obligations or work, let alone take on the obvious expenses of accommodations and treatment involved in the cure. Women took the treatment in disproportional numbers from men, but may have been kept out of asylums with its help. Even though some patients deplored this cure, surely it was better for both reputation and psyche than a stay in a madhouse.

Dr. S. Weir Mitchell was the leading authority on treatment through the rest cure, and was highly influential in popularizing it during the late 1800s. The rest cure worked in two ways: like a stay in an asylum, the rest cure took patients out of their homes and isolated them from whatever atmosphere, people, or situation had caused the problem; the cure secondarily worked on their body and mind by keeping patients at rest in a pleasant, cheerful environment.

Patients were literally forced to rest in a bed for six to eight weeks; massage and electrical stimulation helped keep their muscles toned during the enforced inactivity. Patients were washed by nurses, who also fed them a milk-based diet; milk alone might be given for the first week, or raw eggs if a patient couldn’t tolerate milk. Feeding was nearly continuous, and patients could be force-fed if they would not voluntarily down the quantities the staff tried to give them. Sometimes patients were not allowed to read, talk, or enjoy even the most minimally physical amusements. This probably separated the patient who merely wanted a change of pace or sanctioned escape from an unpleasant household situation from patients who truly needed care.

Patient Undergoing Rest Cure

Patient Undergoing Rest Cure

Dr. Mitchell at the Infirmary for Nervous Diseases, Philadelphia, 1902, courtesy National Library of Medicine

Dr. Mitchell at the Infirmary for Nervous Diseases, Philadelphia, 1902, courtesy National Library of Medicine

Keeping Up

Outlines of Psychiatry

Outlines of Psychiatry

Like most people, Dr. Harry Hummer, superintendent of the Canton Asylum for Insane Indians, had a number of contradictory traits. Though he was accused of poor record-keeping on his patients and of a failure to institute any kind of mental health plan for them, he was clearly interested in maintaining expertise in his field. Continue reading

More Rules

Patients Demonstrate Hand Restraints, 1915, courtesy The Burns Archive

Patients Demonstrate Hand Restraints, 1915, courtesy The Burns Archive

The Indian Office provided rules for attendants working at the Canton Asylum for Insane Indians which were thorough and explicit; similar instructions were most likely the case in all other insane asylums. Patients were supposed to “preserve order” but only by using the mildest means possible. Rule 20 stated: “No kicking, striking, shaking, or choking of a patient will be permitted under any circumstances. Patients must not be thrown violently to the floor in controlling them, but the attendant shall call such assistance as will enable him to control the patient without injury.”

This rule was broken any number of times, and at least one male attendant was fired for committing unwarranted violence against patients. Mechanical restraints like cuffs and camisoles (straitjacket) were to be used only with the consent of the physician or superintendent, but employees did not follow this rule. Instead, they got restraints from the financial clerk simply by asking for them. Dr. Hummer, who later received very harsh criticism for the asylum’s excessive use of restraints, either permitted their use (though he often said restraints weren’t used) or he abdicated his responsibilities to the financial clerk. Either way, he had to know that employees were using restraints quite freely . . . unless he wasn’t making rounds often enough to catch it. Whatever the reason for all the restraints, Dr. Hummer was responsible for the situation.

Medical Staff at Willard Asylum

Medical Staff at Willard Asylum

Staff of Arizona State Asylum, 1914

Staff of Arizona State Asylum, 1914

And the Patients’ Side

Patient Dining Room at West Virginia Hospital for the Insane, 1912

Patient Dining Room at West Virginia Hospital for the Insane, 1912

Employees at the Canton Asylum for Insane Indians had clear instructions concerning their duties, including the all-important attendants who were at the heart of patient care. (See last post.) They were charged with keeping rooms neat and clean, attending to their patients’ needs in terms of clothing and personal care–basically what anyone would expect of an institution set up to care for the insane. The reality was often different, and the conditions many patients lived under would have been disheartening.

Though foreign to their own experience on or off a reservation, patients arriving at Canton Asylum when it first opened would have walked into a spacious, light-filled building. Electricity and running water might have been exciting to use, and regular meals supplemented by garden produce would have been tasty and welcome. As the asylum deteriorated over the years, however, patient comfort declined. The early structure had been pretty and airy, with pictures on the walls and nice furniture. As time went on, the pictures disappeared; the floors, clothes, and bedding became dingy and worn; and the nourishing food evolved into a monotonous diet of starches and vegetables. Patients used chamber pots instead of toilets, which allowed human waste to create a stench and promote disease in the midst of crowded rooms.

By the time the asylum closed, one inspector likened patient care at the asylum to that of a prison. Patients who had been sent to the institution for mental problems received no mental health care at all–the whole purpose for the asylum. Ultimately, authorities concluded that almost no amount of money could make the asylum function  as it should and decided to shut it down.

Female Ward at Athens Lunatic Asylum, 1893

Female Ward at Athens Lunatic Asylum, 1893

Women's Sewing Room at Spring Grove, 1910s

Women’s Sewing Room at Spring Grove, 1910s

Keeping Busy

Clarinda State Hospital

Clarinda State Hospital

Insane asylums tried to be self-sufficient, but in our modern era it can be hard to understand just how self-sufficient they were.  The Clarinda State Hospital in Iowa was one of many similar institutions that used patient labor for the dual purpose of keeping operating costs down and giving patients something to do. The asylum employed patients (under direction) to sew nearly all the clothing they needed, and to make shoes under the direction of a shoemaker. Patients also engaged in woodworking and made brooms from broom corn raised on the asylum farm. A bit more unusual was the facility’s mattress-making department, where all the new mattresses for the asylum were made.

“Mattress hair is bought and also a good quality of material for the cover, which is made up in the sewing room and afterwards filled by patients. . . . Soiled or worn mattresses in which the hair has become packed are taken apart, thoroughly renovated by steam, dried, thoroughly picked and the hair used over again.”

The writer ended his description of the asylum with the words that: “The general spirit of the institution is to have the asylum idea as much in the background as possible and to supply surroundings and influences as much like those at home as can be made.”

It would be difficult to discover whether this aim had been achieved.

Men Working in Broom Factory at Oak Forest, IL Poorhouse, circa 1915, courtesy Library of Congress

Men Working in Broom Factory at Oak Forest, IL Poorhouse, circa 1915, courtesy Library of Congress

Patients Making Rugs, Hammocks, Baskets, etc. at Hudson River State Hospital in Poughkeepsie, NY, 1909

Patients Making Rugs, Hammocks, Baskets, etc. at Hudson River State Hospital in Poughkeepsie, NY, 1909

Alienists’ Diagnoses Were Never Foolproof

Nellie Bly, circa 1890

Nellie Bly, circa 1890

Alienists’ assessments of their patients’ mental conditions could be suspect at the best of times. They were particularly suspect when alienists dealt with people who did not fit the norms of an Anglo-centric society. Newly arrived immigrants were vulnerable to a misinterpretation of their mental status, and of course, non-English speaking Native Americans could easily be misunderstood or be so frustrated and frightened that they couldn’t communicate effectively. Continue reading

Canton’s Patients

Canton Asylum with Swing Sets

Canton Asylum with Swing Sets

Few patient records from the Canton Asylum for Insane Indians are intact or complete. This is not unusual–many asylums destroyed their records over the years, since early administrators did not see any potentially historical value in them. The Canton Asylum’s records are especially problematic, though, since its superintendent, Dr. Harry Hummer, was faulted several times for a failure to even keep good records. What never existed cannot very well be found, in many cases. There are a few records that remain, and when patients were transferred to St. Elizabeths after the Canton Asylum closed, staff observed them for a period of time and then summarized the patient’s history and current behavior (see last post). Here is an example of their summation of a patient:

Nesba (Tribe – Navajo)

She was admitted to the Canton Asylum . . . at the request of the Superintendent of Southern Navajo Agency, Fort Defiance, Arizona. The medical certificate at the time stated, “The patient has been in present condition for past two years. Present symptoms, feeblemindedness, dementia.” The patient is a congenital defective suffering with cerebral palsies. . . . During her stay in the Canton Asylum she was infantile in her reaction, subject to tantrums during which she cried and yelled, sang, etc. These periods seemed to coincide with her menstrual periods. At one time during her stay there she was quite destructive to clothing . . . she mimicked people and seemed to delight in teasing other patients.

On her admission here the patient was passively cooperative but unable to stand alone due to her physical handicap. She is mute except for guttural noises which she makes in her throat. No definitive mental content can be elicited. She smiles at any attention received, is quite highly pleased at any effort of others to associate with her.

Other remarks continued to assess the patient’s physical condition and mental status, but staff said it was “impossible to determine whether she is oriented or if her memory is better.” She had been admitted to Canton Asylum in 1924 when she was about 20 years old, so would have been around 30 when she came to St. Elizabeths. Her physical condition probably brought her to and kept her in an asylum.

My next post will give one more patient history.

Group of Female Patients, Eastern Hospital for the Insane, courtesy National Institutes of Health

Group of Female Patients, Eastern Hospital for the Insane, courtesy National Institutes of Health

 

Acute Insanity as Cause of Death

Acute Insanity as Cause of Death

Make it Pretty

Exhibition of Fancy Work, 1908, courtesy Willard

Exhibition of Fancy Work, 1908, courtesy inmatesofwillard.com

Occupational therapy was an important part of patient care in nearly all asylums. Patients were encouraged to do skilled work that got their minds off their problems/issues and produced a tangible object in which they could take pride. Genteel ladies might do fancy sewing while men engaged in woodwork, even in an elite asylum such as the McLean Asylum for the Insane in Massachusetts.

Indian patients at the Canton Asylum for Insane Indians were also encouraged to do crafts like beadwork and basket weaving if they so desired, to help pass time. (Peter Thompson Good Boy spent time “beading” at St. Elizabeths during his stay there beginning in 1913.) Occasionally, patients like Lizzie Vipont earned a little bit of money with their beadwork by selling items to visitors. Necklaces and handbags seemed to be most popular–or at least are mentioned most often. One report mentions that men whittled wooden objects, but went on to say that women were the primarily crafters. The asylum’s second superintendent, Dr. Harry Hummer, also allowed these kinds of occupations, but apparently stopped encouraging it so that the practice fell by the wayside.

This photo appeared in USA Today. Artifacts left over from the Hiawatha Insane Asylum for Indians in Canton, S.D. are displayed at the Canton Public Library on April 23, 2013. Photo: Elisha Page, Sioux Falls, S.D. Argus Leader

This photo appeared in USA Today. Artifacts left over from the Hiawatha Insane Asylum for Indians in Canton, S.D. are displayed at the Canton Public Library on April 23, 2013. Photo: Elisha Page, Sioux Falls, S.D. Argus Leader

 

Occupational Therapy, Toy Making in WWI-Era Psychiatric Hospital, courtesy Otis Historical Archives, National Museum of Health and Medicine

Occupational Therapy, Toy Making in WWI-Era Psychiatric Hospital, courtesy Otis Historical Archives, National Museum of Health and Medicine

Policies and Procedures

Full Men's Ward, Fergus Falls State Hospital, 1900

Full Men’s Ward, Fergus Falls State Hospital, 1900

No asylums had an overabundance of staff, and asylum administrators walked a fine line between doing what was necessary and convenient for their personnel, and what was best for patients. A 1906 article in The American Journal of Insanity discussed the pros and cons of hiring night nurses and unlocking patients’ doors at night. The superintendent of the Missouri State Hospital No. 2 wrote that after doing away with the system of night watches–who passed through the halls and wards once an hour–and going instead to a full staff of night nurses, the incidence of suicide immediately dropped. Patients were also much more comfortable and quiet.

“The idea of locking one, two …seven or eight patients in a room or dormitory, expecting patients to remain quiet, to sleep well, and to get well, is not only absurd,but is inhuman,” Dr. C. R. Woodson wrote. “The morbidly suspicious should certainly not be blamed for imagining that there was danger when locked up in a remote room of an institution with those who may or will domineer over them.”

Woodson went on to say that even violent patients responded well to the unlocked door policy. “The fact that a patient can get up and go to the toilet-room when he wants to, get a drink of water, or even get up and look down the hall, is a source of satisfaction; it makes him less rebellious, less obstinate, and less violent.”

Woodson was doubtlessly correct, and it is strange that it would have taken practitioners in the field so long to circle back to Philippe Pinel’s discovery in the early 1830s that removing chains from the madman did much to subdue his violence.

Restraints for Patients, courtesy National Library of Medicine

Restraints for Patients, courtesy National Library of Medicine

Nursing Students at Minnesota's Third Hospital for the Insane, 1900s

Nursing Students at Minnesota’s Third Hospital for the Insane, 1900s